Methods and systems for electroporation

1. A method of triggering electroporation, the method comprising:

inserting a lead in or around a heart of a patient, the lead comprising a first electrode, a second electrode, and a third electrode that are both sensing and delivering electrodes, wherein a distance between the first electrode and the third electrode is greater than a distance between the first electrode and the second electrode;

measuring a first electrocardiogram between the first and second electrodes of the lead, wherein the first and second electrodes are located linearly along the lead;

measuring a second electrocardiogram between the first and third electrodes of the lead, wherein the first and third electrodes are located linearly along the lead;

comparing the first and second electrocardiograms;

identifying signals common to the first and second electrocardiograms;

removing the signals common to the first and second electrocardiograms, thereby creating a modified electrocardiogram;

determining whether the modified electrocardiogram comprises a cardiac signal; and

in response to determining that the modified electrocardiogram comprises the cardiac signal, delivering electroporation stimulation to the heart using at least one of the first, second, and third electrodes after the cardiac signal is determined.

2. The method of claim 1 , wherein the delivering electroporation stimulation to the heart further comprises:

(a) delivering a first set of stimulation pulses for a cardiac cycle, wherein the first set of stimulation pulses has a first intensity below a threshold;

(b) delivering a second set of stimulation pulses for the cardiac cycle, wherein the second set of stimulation pulses has a second intensity above the threshold;

(c) delivering a third set of stimulation pulses for the cardiac cycle, wherein the third set of stimulation pulses has a third intensity between the first intensity and the threshold; and

(d) delivering a fourth set of stimulation pulses for the cardiac cycle when summation is not detected, wherein the fourth set of stimulation pulses has a fourth intensity above the threshold.

3. The method of claim 1 , wherein the measuring of the first electrocardiogram further comprises detecting a summation in a portion of the first electrocardiogram of a cardiac cycle.

4. The method of claim 2 , wherein the delivering electroporation stimulation to the heart further comprises inhibiting stimulation during a portion of the cardiac cycle when summation is detected.

5. The method of claim 1 , wherein the measuring of the second electrocardiogram further comprises detecting a second summation in a second portion of the second electrocardiogram of a cardiac cycle.

6. A device for delivering electroporation, the device comprising:

a lead comprising a first electrode, a second electrode, and a third electrode that are both sensing and delivering electrodes, wherein the electrodes are positioned linearly along a length of the lead and, wherein a distance between the first and the third electrode is greater than a distance between the first and second electrode;

a memory that is capable of storing computer executable instructions; and

a processor that is configured to facilitate execution of the executable instructions stored in memory, wherein the instructions cause the processor to:

measure cardiac signals from at least one of the first, second, and third electrodes on the lead,

wherein the measuring of cardiac signals comprises:

(a) measuring a first between the first and second electrodes;

(b) measuring a second electrocardiogram between the first and third electrodes;

(c) comparing the first and second electrocardiograms;

(d) identifying signals common to the first and second electrocardiograms;

(e) removing signals common to the first and second electrocardiograms, thereby creating a modified electrocardiogram; and

(f) determining whether the modified electrocardiogram comprises a cardiac signal; and

in response to determining that the modified electrocardiogram comprises the cardiac signal, deliver electroporation stimulation to a heart using at least one of the first, second, and third electrodes after the cardiac signal is determined.

7. The device of claim 6 , wherein the delivery of electroporation stimulation to the heart further comprises:

(a) delivering a first set of stimulation pulses for a cardiac cycle, wherein the first set of stimulation pulses has a first intensity below a threshold;

(b) delivering a second set of stimulation pulses for the cardiac cycle, wherein the second set of stimulation pulses has a second intensity above the threshold;

(c) delivering a third set of stimulation pulses for the cardiac cycle, wherein the third set of stimulation pulses has a third intensity between the first intensity and the threshold; and

(d) delivering a fourth set of stimulation pulses for the cardiac cycle when summation is not detected, wherein the fourth set of stimulation pulses has a fourth intensity above the threshold.

8. The device of claim 6 , wherein the measuring cardiac signals further comprises detecting a summation in a portion of an electrocardiogram of a cardiac cycle.

9. The device of claim 8 , wherein the delivery of electroporation stimulation to the heart further comprises inhibiting a delivery of electroporation stimulation during the portion of the cardiac cycle when summation is detected.

10. The device of claim 8 , wherein the measuring cardiac signals further comprises detecting a second summation in a second portion of a second electrocardiogram of the cardiac cycle.